IV CONTRAST ReactionsTreating Problems

DOSE-DEPENDENT SYSTEMIC REACTIONS ("IV CONTRAST Reactions Treating Problems")

Nausea and vomiting, a metallic taste in the mouth, and generalized warmth or flushing that are associated with contrast material injection are usually nonlife-threatening, self-limited problems. Slow intravenous injection (over two minutes rather than over 10 seconds) decreases the incidence of headache and metallic taste. The rate of infusion, rapid or slow, does not make a difference in the development of nausea or vomiting.General supportive care of the patient usually suffices in the management of these reactions.

RENAL FAILURE ("IV CONTRAST REACTIONS TREATING PROBLEMS")

Monitoring patients for the development of renal failure after the administration of contrast material requires observation of the patient's renal function for at least three days. A rising serum creatinine level is usually the first sign of an impending change in renal function, but elevation of the serum creatinine level may not occur for 72 hours. However, the serum creatinine level often rises within the first 24 hours and peaks in three to five days. The patient's creatinine level usually returns to baseline by seven to 10 days after the procedure.

Electrolytes should be checked daily to ensure that hyperkalemia is not occurring. The patient's intake and output should be measured as a gross indication of renal function. Most cases of contrast-induced renal failure resolve with supportive measures such as adequate hydration and adjustment of electrolyte abnormalities. The above measures are usually adequate for renal support; rarely is dialysis or transplantation required.

ANAPHYLACTIC REACTIONS ("IV CONTRAST REACTIONS TREATING PROBLEMS")

The principles of advanced cardiac life support should be followed in the treatment of anaphylactic reactions to contrast material. Stabilization of the patient's airway, cardiac function, and blood pressure is the fundamental element of treating anaphylactic reactions. In patients who develop bronchospasm, laryngeal edema, or severe urticaria or angioedema, epinephrine should be administered immediately (0.3 to 0.5 mg subcutaneously every 10 to 20 minutes). Patients with bronchospasm should be given 50 mg of hydrocortisone or 50 mg of methylprednisolone.

Radiology personnel who have direct contact with patients should be familiar with and certified in providing emergency care. Radiology departments must be equipped and their personnel trained to respond to life-threatening reactions at any time.

DELAYED REACTIONS ("IV CONTRAST REACTIONS TREATING PROBLEMS")

Symptoms of delayed reactions (nausea, vomiting, abdominal pain, fluid overload, and fatigue) usually resolve spontaneously and require only supportive management.

EXTRAVASATION ("IV CONTRAST REACTIONS TREATING PROBLEMS")

Application of ice packs and heating pads, and elevation are used to alleviate the symptoms associated with extravasation of contrast material. Tissue damage is more likely to occur with extravasation of ionic contrast material than with nonionic contrast agents.